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Doctors Miss Alcohol Screening Opportunities

Physicians often fail to counsel their young adult patients about excessive alcohol use, a new study found.

Excessive alcohol consumption is a common cause of injury and death among young adults. Guidelines for low-risk drinking set by NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) call for men to have no more than 4 alcohol drinks a day and no more than 14 drinks per week. For women, the guidelines call for 3 or fewer drinks per day and no more than 7 drinks per week.

Studies have shown that screening and brief interventions by health care providers can promote significant, lasting reductions in drinking levels and alcohol-related problems. This includes asking patients about alcohol use and advising them to reduce risky drinking. NIAAA and others recommend routine screening for alcohol misuse in primary care.

Dr. Ralph W. Hingson of NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) and his colleagues set out to investigate whether patients were getting this routine screening. The researchers conducted a random survey of more than 4,000 people between the ages of 18 and 39. Those who said they had visited a doctor in the past year were asked whether the doctor had assessed their alcohol use and advised them about safe drinking practices. The results appeared in the September 21, 2011, issue of the Journal of General Internal Medicine.

The researchers found that 16% of those surveyed were non-drinkers, 24% drank at or below daily or weekly limits, 47% exceeded daily or weekly limits and 13% exceeded both. Two-thirds of the people had seen a doctor in the past year. Of those whose drinking exceeded the NIAAA guidelines, only 49% recalled being asked about their drinking, and only 14% were counseled about it.

Young adults between ages 18 and 25 were the most likely to report drinking in excess of NIAAA guidelines. However, only 34% of them were asked about drinking by their doctors, compared with 54% of adults ages 26 to 39.

“In the United States, excessive alcohol use is the third leading preventable cause of death,” says NIAAA Acting Director Dr. Kenneth Warren. “It's also a significant cause of disability for men and women in this country. The findings reported by Dr. Hingson and his colleagues indicate that we must redouble our efforts to help clinicians make alcohol screening and brief intervention a routine part of patient care in the United States.”